Comparing Medicare and Medicaid

New York State Medicaid Lawyer - Law Office of Andrew M. Lamkin, P.C. Medicaid and Medicare have very similar names, and they can both help you pay your medical bills, but they are very different programs.

Medicaid is for low-income people in financial need. On the other hand, Medicare assistance is not based on need; instead, eligibility is based on age and work history.

Although you can qualify and receive benefits from both Medicaid and Medicare at the same time, you will be required to meet separate eligibility requirements for each program.

Here is how Medicare and Medicaid compare:


Medicare is administered by the federal government, linked to social security and established to address the high cost of medical care that older people face, especially given the reduced earning capacity of retired people. An individual’s financial need, however, is irrelevant when it comes to their eligibility to receive Medicare. Instead, they are entitled to Medicare because they paid for it with their taxes.

Medicare is available to US citizens who are at least 65 years old and have paid Medicare taxes for at least 10 years. It is also available to certain people receiving disability through Social Security and some people with long-term kidney disease.

Medicare Hospital Insurance (Part A) covers the cost of medical care in a hospital or a nursing home facility. Medicare Medical Insurance (Part B) pays for most basic lab costs and outpatient needs, such as medical supplies, home health care, and physical therapy. Medicare Prescription (Part D) covers a part of the costs of prescription medications.


Medicaid is a joint Federal and State program, and like Medicare, its purpose is to address the high cost of health care for low-income individuals and families who cannot afford the cost of medical treatment or long-term custodial care.

Medicaid in New York can be divided into two main types:

  1. Community Medicaid, which covers medication and comprehensive inpatient and outpatient care at hospitals and clinics;
  2. Institutional Medicaid, which covers care provided in nursing homes.

Medicaid is generally available to people with low incomes and children under the age of 19. But it is also available to pregnant women and individuals over 65, as well as those who are blind, disabled or in need of nursing home care.

In order to qualify for Medicaid in New York, you must reside in the state of New York and meet strict financial guidelines related to your living situation, family status, age, and health.

Other Differences Between Medicare and Medicaid

Medicare Part A and D require you to pay an annual deductible and copayments for long hospital stays. In addition, Under Part B, you are required to pay a monthly premium and 20% of all doctors’ bills not paid by Medicare. Under Medicare Part D, you pay a monthly premium, a deductible, copayments and all prescription medication cost above a certain amount, unless you qualify for a low-income subsidy.

Medicaid benefits, on the other hand, are paid by Medicaid directly to health care providers, hospitals, and nursing homes. And, if you qualify for both Medicare and Medicaid, Medicaid will pay for most of your Medicare Part A and Part D premiums, deductibles, and copayments as well.

Finally, you apply for Medicare at a local Social Security Office while for Medicaid you will need to apply in an office for New York City’s Medicaid program or online through the New York State of Health Exchange.

How Can a New York Medicaid Lawyer Help?

Obtaining Medicaid is a complicated application and eligibility process. The Law Office of Andrew M. Lamkin, P.C. is aware of all the intricacies of Medicaid law and can work with you to determine the best way to protect your assets and income for your family.

Call 516-605-0625 or contact me online to schedule an appointment with an experienced Long Island (LI) Medicaid Attorney. I am available to meet with you at your home or my office.

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